September 16, 2008
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Discharged.
Mrs W, a 63 year old woman was cooking in her kitchen when she slipped and fell, fracturing her right hip. She was admitted to the medical floor due to her history of end stage renal disease on dialysis, hypertension, and diabetes. A surgical consult was placed, and Mrs W underwent a successful open reduction internal fixation for her hip, and the plan was to discharge her after she recovered from surgery.
On post op day 3, Mrs W seemed slightly altered when I went in to see her on pre-rounds. While she was normally responsive, she was doing nothing but grunting in response to my questions. I asked her if she could understand and she grunted mm-hmm. I followed it up by asking how her pain was, and she grunted something uninteligible. On reporting these finding to my senior resident, we ordered a CT scan of her head, because we were worried about a stroke. We made sure she was on anticoagulation, and signed her out to the on call team
The next morning, I was running late on writing my notes before morning report. Went in to speak with Mrs W but she was still sleeping, so I just skipped it, figuring I would go back and see if her status had improved later, once her labs and vitals were up on the computer.
Then I ran into the on call team during morning report, who informed me that my patient had died during the night. She was found unresponsive, a code was called, but she was unable to be revived, and likely had been dead when she was discovered by the nurse.
The family did not want an autopsy, but our suspicion was a massive thromboembolism (blood clot).
Could this have been prevented? Was everything done that could have been done? I guess I will never know.
-Almost Dr J
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Why Not Zoidberg
Comments (8)
Awww… That’s so sad. I don’t know how you can do that.. It takes a lot of strength and eventual detachment to be able to handle death like that… I’m a big wuss and would have been crying my eyes out… Needless to say, I don’t think I could cut it in any of the medical fields.
yikes
Hearing stories like that really brings things into perspective. Life’s just too short.
it is always sad when someone passes. It is even worse not knowing what exactly happened. I cared for an elderly woman and her geriatric Dr told me I didn’t know what the hell was going on. A week later she was dead at 63. The family did the autopsy and found that I was right…she had suffered several massive strokes (that she convulsed through) and that is what lead to her death…if the Dr had listened to me she would have been cared for on time.
He is no longer a geriatric dr.
@JHawkJulie - nope, we have an intern year…its to remind us why we wanted the lifestyle specialty so badly in the first place
Celestial discharges are always rough. The unfortunate thing is that even though you could look through her record and see that everything was done according to the standard of care, there’s still that nagging feeling. But I guess that’s what drives us all to do better.
Oh… and I was curious, do opthos have to do an IM intern year, or are they super-cool like OB-Gyn’s and get to bypass that internal medicine crap?
@CarmenDeBizet - well there are a few things that I had to leave out of the story for HIPAA purposes, but yeah, you basically got the gist.
What I don’t understand is why the family did not want an autopsy (perhaps religious reasons?)…
It is an eye-opening experience to see what one can see at a hospital through your lens. That lady went in with a broken hip and is now dead. If that would have been my relative, I would want more information.